iNTELLECTUAL DISBILITY AND SPECIFIC LEARNING DISORDER

1. DR SEEMA RAI
ASSISTANT PROFESSOR
DEPARTMENT OF PEDIATRICS
GURU GOBIND SINGH MEDICAL COLLEGE,FARIDKOT

2. INTELLECTUAL DISABILITY
Adaptive function Intellectual function

3.  Age of onset before maturity (<18 years) is reached.
 Estimated prevalence 2.5%-5%, males are more
affected.

4. ADAPTIVE FUNCTION
 Skills that are required for daily functioning.
 Deficit in any 2 of the following .
1. Conceptual skills
2. Social skills
3. Practical skills

5. INTELLECTUAL FUNCTION
 Performing an individually administered test
measuring IQ .
 Cut off <70
1. Mild = 55-69
2. Moderate = 40-54
3. Severe = 25-39
4. Profound = <20

7. COMMON PRESENTATIONS
AGE AREA OF CONCERN
Newborn Dysmorphism, organ dysfunction
Early infancy (2-4 month) Poor interaction, vision & hearing
impairment
Later infancy (6- 18 months) Gross motor delay
Toddler (2-3 years ) Language delays
Preschool (3-5 years) Language delay, behavior difficulties
School age (> 5 years) Poor academic performance

8. SCREENING
 Patients with developmental delay.
 Parents, School teacher labeled poor / slow learner.

9. MEDICAL DIAGNOSTIC
 Neuroimaging
 EEG
 Karyotyping
 Tandem mass spectrometry
 Thyroid function test

10. DIAGNOSIS Child/ clinical psychologists for Adaptive functioning and
IQ test.
1. Testing. The tools that can be used for the same include:
(i) Adaptive functioning: VSMS(Vineland Social Maturity
Scale)
(ii) IQ testing: BKT (Binet Kamat intelligence test/ MISIC
(Malin’s intelligence scale for Indian children.
 Based on the above the diagnosis of ID will be confirmed.
Based on adaptive functioning assessment, severity scoring
will be done and disability for ID charted

11. Vinland Social Maturity Score
Eight social areas:
 Self-help General (SHG)
 Self-help Eating (SHE)
 Self-help Dressing (SHD)
 Self direction (SD)
 Occupation (OCC)
 Communication (COM)
 Locomotion (LOM)
 Socialization (SOC)

12. Test Items
0- 1 Year
1. “Crows”, Laugh
2. Balance head
3. Grasps objects within reach
4. Reaches for familiar persons
5. Rolls over, (unassisted)
6. Reaches for nearby objects
7. Occupies self-upright
8. Sits unsupported
9. Pulls self upright
10. “Talks”, imitates sounds
11. Drinks from cup or glass assisted
12. Moves about on floor (creeping,
crawling)
13. Grasps with thumb and finger
14. Demands personal attention
15. Stands alone
16. Does not drool
17. Follows simple instructions
1- 2 Year
18. Walks about room unattended
19. Marks with pencil or crayon or chalk
20. Masticates (chews) solid or semi-
solid food
21. Pulls off clothes
22. Transfers objects
23. Overcomes simple obstacles
24. Fetches or carries familiar objects
25. Drinks from cup or glass
26. Walks without support
27. Plays with other children
28. Eats with own hands (biscuits,
bread, etc.)
29. Goes about hours or yard
30. Discriminates edible substances
from
non-edibles
31. Uses names of familiar objects
32. Walks upstairs unassisted
33. Unwraps sweets, chocolates
34. Talks in short sentences

13. 2- 3 Years
35. Signals to go to toilet
36. Initiates own play activities
37. Removes shirt to or frock if
unbuttoned
38. Eats with spoon/hands (food)
39. Gets drink (water) unassisted
40. Dries own hands
41. Avoids simple hazards
42. Puts on short or frock unassisted
(need not
button)
43. Can do paper folding
44. Relates experience
3- 4 Years
45. Walks downstairs, one step at a time
46. Plays co-operatively at kindergarten
level.
47. Buttons shirt or frock
48. Helps at little household tasks
49. “Performs” for others
50. Washes hands unaided
4- 5 Years
51. Cares for self at toilet
52. Washes face unassisted
53. Goes about neighborhood
Unattended
54. Dresses self expect for trying
55. Uses pencil or crayon or chalk for
drawing
56. Plays competitive exercise games
5- 6 Years
57. Uses hoops, flies kites, or uses knife
58. Prints (writes) simple words
59. Plays simple games which require
talking
turns
60. Is trusted with money
61. Goes to school unattended
6- 7 Years
62. Mixed rice “properly unassisted
63. Use pencil or chalk for waiting
64. Bathes self assisted
65. Goes to bed unassisted

14. 7- 8 Years
66. Can differentiate between AM
& PM
67. Helps himself during meals
68. Understands and keeps family
secrets
69. Participants in pre-adolescent
70. Combs or burses hair
8- 9 Year
71. Uses tools or utensils
72. Does routine household tasks
73. Reads on own initiative
74. Bathes self unaided
9- 10 Years
75. Cares for self at meals
76. Makes minor purchase
77. Goes about home town freely
10- 11 Years
78. Distinguishes between friends any play
mates
79. Makes independent choice of shops
80. Does small remunerative work
81. Follows local current events
11- 12 Years
82. Does simple creative work
83. Is left to care for self or others
84. Enjoys reading books,
newspapers and magazines
12- 15 Years
85. Plays difficult games
86. Exercises complete care of dress
87. Buys own clothing accessories
88. Engages of adolescent group activities
89. Performs responsible routine chores

15. DISABILITY CALCULATION
 The disability calculation will be done based on VSMS
score.
(i) VSMS score 0-20: Profound Disability-100%
(ii) VSMS score 21-35: Severe Disability-90%
(iii) VSMS score 36-54: Moderate Disability-75%
(iv) VSMS score 55-69: Mild Disability-50%
(v) VSMS score 70-84: Borderline Disability-25%

16. CERTIFICATION
 The minimum age for certification will be one (01)
completed year. Children above one year and up to the
age of 5 years shall be given a diagnosis as Global
Developmental Delay (GDD).
 Children above the age of 5 years shall be given a
diagnosis and certificate as Intellectual Disability.

17. GLOBAL DEVELOPMENT DELAY
 Delay in acquiring milestones in two or more domains

18. MEDICAL BOARD
 The Medical Superintendent or Chief Medical Officer
or Civil Surgeon or any other equivalent authority as
notified by the State Government
 Pediatrician or Pediatric Neurologist (where
available)/ Psychiatrist or Physician (if age >18years)
 Clinical or Rehabilitation Psychologist
 Psychiatrist

19. VALIDITY
 Temporary certificate for children less than 5 years:
The certificate will be valid for maximum 3 years/ 5
years age (whichever is earlier).
 For children more than 5 years: The certificate will
mention a renewal age. The certificate will have to be
renewed at age of 5 years, 10 years and 18 years. The
certificate issued at 18 years of age will be valid
lifelong.

21. SPECIFIC LEARNING DISORDER
 Deficit in scholastic skills (DSM5th edt)
 Deficit in processing language, spoken or written
reading and mathematics.

22. CLINICAL SPECTRUM
 Dyslexia (reading disorder)
 Dysgraphia (written language disorder)
 Dyscalculia (mathematics disorder)
 Dyspraxia (coordination disorder)
 Developmental aphasia ( inability to formulate
language)

23. ETIOLOGY
Chromosomal disorder Turner syndrome, Digeorge
syndrome
Perinatal insults Very low birth weight, IUGR, HIE
Environmental toxin Lead, cocaine drug abuse

24. SCREENING
 The teachers of the public and private school shall
carry out the screening in Class III or at eight years of
age, whichever is earlier.
 If in the screening shows test three or more answers
are in “frequently” column, then the child should be
referred for further assessment

25. DIAGNOSIS
 Step 1- Assessment of paediatrician: The paediatrician will
do the initial assessment. This will involve a detailed
neurological examination including vision and hearing
assessment. It has to be ensured that the child has normal
visual acuity and hearing before proceeding to next step.
 Step 2: IQ Assessment: Child/ clinical psychologist will do
the IQ assessment using MISIC or WISCIII. If the IQ is
determined to be >85, then step 3 will be applied.
 Step 3- SLD Assessment: This would involve application of
specific psychometric tests for diagnosing SLD and giving
it a severity scale.

26. Diagnostic Tool
 National Institute for Mental Health and
Neurosciences (NIMHANS) test.

27. Medical Board
 The Medical Superintendent or Chief Medical Officer
or Civil Surgeon or any other equivalent authority as
notified by the State Government
 Pediatrician or Pediatric Neurologist (where available)
 Clinical or Rehabilitation Psychologist
 Occupational therapist or Special Educator or Teacher
trained for assessment of SLD.

28. Validity of Certificate
 The certification will be done for children aged eight
years and above only. The child will have to undergo
repeat certification at the age of 14 years and at the age
of 18 years.
 The certificate issued at 18 years will be valid life-long.

29. Teachers complain of poor understanding/drop in school
grades
Teachers applies screening test and refers the child with anomaly to school committee/principal
Referred for SLD assessment with letter by principal and teacher’s screening
Assessed by pediatrician with detailed neurological examination for comorbidities
Chalk out the domains affected and involvement of visual/hearing abilities
Assessment by psychologist with specific tests for IQ using MISIC/WISC-III
If IQ> 85, do the specific test for SLD
SLD confirmed
Severity assessment
Board assess and certifies
Re-certification at 14 years and 18 yrs. age
Include other disabilities if present